By Dr. Chris Tonozzo, MD, Director of Data Quality

You have likely heard about the high cost of health insurance in our mountain communities, and if you’ve been listening a little more closely, you’ve also heard about the high cost of the health care itself. How does Mountain Family Health Centers measure up in terms of the amount spent to care for our patients?

Mountain Family measures the “total cost of care” (TCC) for our patients. TCC is the amount spent throughout the healthcare system, and is usually measured on a per patient basis. This includes the care we provide at Mountain Family, as well as hospital costs, pharmaceutical costs and diagnostic studies (such as x-rays or laboratory tests). This is difficult to measure, since we at Mountain Family do not know how much is spent on our patients outside of our facility. Fortunately, Colorado has a resource called the All Payer Claims Database (APCD). The APCD Council was enacted into law in 2012 to collect as much financial information as possible on the cost of care provided to Coloradans. Medicaid, Medicare and the 20 largest insurers in Colorado participate by providing data on all the monies they spent in health care for all patients who are covered by them. It does NOT include the costs of uninsured patients, unfortunately, as it is only insurance data.

The APCD, via an organization called the Center for Improving Value in Health Care (CIVHC) publishes reports on total cost of care. CIVHC breaks down the data to show how much is spent for different counties and differentiates by Medicaid, Medicare and commercial insurance (such as Cigna or Blue Cross Blue Shield). Below is a graph of how the total cost of care has looked for the last three years (2016 data has not yet been released). The graph shows the number of dollars spent per insured person for each year. The top (blue) line is the TCC for commercially insured individuals and the bottom (green) line is the TCC for Medicaid patients. This represents all people covered by public or private insurance in Garfield, Pitkin and Eagle Counties, Mountain Family’s service area. Mountain Family sees the majority of Medicaid patients in our service area.

As the graph illustrates, cost of care for Medicaid patients is significantly lower than the cost of care for commercially insured patients. Since Mountain Family is the predominant provider for Medicaid in these counties, we can take credit for keeping the TCC much lower for the patients we care for. Mountain Family accomplishes this by keeping patients out of the hospital, being judicious with the use of diagnostic tests, addressing all aspects of the patient’s health (including behavioral or dental health) and/or prescribing lower cost medicines when appropriate.